Does stopping amiodarone after successfully treating atrial fibrillation occurring after cardiac surgery increase the risk of recurrence?
OBJECTIVE
Atrial fibrillation (AF) following cardiac surgery is common and can complicate postoperative recovery. Amiodarone is a drug frequently used for cardioversion. Some clinicians advocate only in-hospital use of amiodarone until cardioversion, whereas others continue its use for several weeks following cardiac surgery. Inadvertent long-term administration of the drug could be harmful. This study assessed the risk of AF recurrence under 2 different regimens of amiodarone treatment.


METHODS
From January 2005 to July 2007, we reviewed 296 patients who developed postoperative AF. Group A consisted of 198 patients who were discharged on amiodarone treatment, and group B consisted of 98 patients who were discharged without amiodarone treatment. The patients were followed for 8 weeks after cardiac surgery and were observed for the development of symptoms such as palpitations, transient ischemic attack (TIA), stroke, and recurrence of or readmission for AF. In addition, we evaluated a control group of 145 patients with similar characteristics and no postoperative AF for the incidence of stroke and AF and compared the results with their rates in the study groups.


RESULTS
Patients discharged on amiodarone therapy were more likely to experience episodes of palpitations than those not on amiodarone (13% versus 10%); however, the rates of AF recurrence were almost the same for the 2 groups (8% and 9%, respectively). The 2 groups also showed no difference in the incidence of TIA and stroke (5% versus 4%). A low incidence of stroke and AF (1%-2%) was observed in patients with no perioperative AF.


CONCLUSIONS
Long-term treatment of patients with amiodarone should be reconsidered, because it may not be as effective as previously thought in preventing symptoms and AF recurrence. The surprising incidence of neurologic events requires further investigation.
Attaran
Saina
S
Cardiothoracic Department, King's College Hospital NHS Foundation Trust, London, UK. saina.attaran@kcl.ac.uk
Sherwood
Roy
R
John
Lindsay
L
El-Gamel
Ahmed
A
Desai
Jatin
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone; D000889:Anti-Arrhythmia Agents; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000517:prevention & control*; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011292:Premedication / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone